ABSTRACT
BACKGROUND: The implementation of an electronic patient health record (EHR) system in the field of ophthalmology can be a challenging project for many hospitals. Although all hospitals have a hospital information systems (HIS), these systems are often not capable of managing the complexity of ophthalmological patient records. METHODS: This article reports the implementation of an ophthalmological EHR into the pre-existing HIS (Agfa-ORBIS; Agfa HealthCare GmbH, Bonn, Germany). The digital record management and the connections to the peripheral examination devices are presented. RESULTS: The EHR developed by us has been in clinical use since 2009 and is subject to continuous further development. Through close cooperation with the IT department, all examination devices could be digitally connected, enabling paperless work and avoiding the drawbacks of paper files. DISCUSSION: The advantages of an EHR implemented into the existing HIS are manifold. Through such a system a complete, interdisciplinary and ubiquitous documentation can take place. The alternative is the acquisition of a third system, which must be connected by an interface with the main system and has significantly higher acquisition and maintenance costs.
Subject(s)
Hospital Information Systems , Ophthalmology , Documentation , Electronic Health Records , Germany , HumansABSTRACT
PURPOSE: Accumulation of lipoprotein-derived lipids including esterified and unesterified cholesterol in Bruch's membrane of human eyes is a major age-related change involved in initiating and sustaining soft drusen in age-related macular degeneration (AMD). The apolipoprotein (apo) A-I mimetic peptide 4F is a small anti-inflammatory and anti-atherogenic agent, and potent modifier of plasma membranes. We evaluated the effect of intravitreally-injected 4F on murine Bruch's membrane. METHODS: We tested single intravitreal injections of 4F doses (0.6 µg, 1.2 µg, 2.4 µg, and placebo scrambled peptide) in ApoEnull mice ≥10 months of age. After 30 days, mice were euthanized. Eyes were processed for either direct immunofluorescence detection of esterified cholesterol (EC) in Bruch's membrane whole mounts via a perfringolysin O-based marker linked to green fluorescent protein or by transmission electron microscopic visualization of Bruch's membrane integrity. Fluorescein isothiocyanate-conjugated 4F was traced after injection. RESULTS: All injected eyes showed a dose-dependent reduction of Bruch's membrane EC with a concomitant ultrastructural improvement compared to placebo treated eyes. At a 2.4 µg dose of 4F, EC was reduced on average by ~60% and Bruch's membrane returned to a regular pentalaminar structure and thickness. Tracer studies confirmed that injected 4F reached intraocular targets. CONCLUSION: We demonstrated a highly effective pharmacological reduction of EC and restoration of Bruch's membrane ultrastructure. The apoA-I mimetic peptide 4F is a novel way to treat a critical AMD disease process and thus represents a new candidate for treating the underlying cause of AMD.
